Extending Professional Identity Formation to develop academic faculty for a new medical school

Academic health centers have a responsibility to foster professional development approaches and engagement environments for faculty to elevate both knowledge and sense of belonging as medical educators. This new educational methods submission depicts faculty development and engagement initiatives implemented at a single institution that were created and influenced by the psychological framework of Professional Identity Formation. The authors suggest ways that academic medical centers can draw upon the formation of these programs to best serve their faculty for cultivating development and engagement for professional growth.


Introduction
Academic health centers have a responsibility to foster professional development environments and systematic approaches for faculty to elevate both knowledge and sense of belonging as medical educators.Commonly used to address the questions, 'who are we?' and 'who do we want to become?', Professional Identity Formation (PIF) is a framework grounded in the psychology of adult development, often used to bridge the gap in physicians and health professionals between who they currently are as care providers and where they want to grow and bridge the gap in other areas (Sarraf-Yazdi et al., 2024;Sarraf-Yazdi et al., 2021).Under the premise of PIF, an individual's development is influenced by social-contextual approaches (Cruess et al., 2019;Jarvis-Selinger et al., 2019).From this lens, PIF can be applied to faculty development and engagement programs to elicit this growth by sharing in communal learning and training, as well as networking with others (Irby & Hamstra, 2016;Silveira et al., 2023).In contrast with the widely reported use of PIF in the training of medical students and trainees, PIF has only recently begun to gain traction for use by academic faculty in medical schools (Mahajan et al., 2022;McMains et al., 2023;Mount et al., 2022).
In this New Educational Methods submission, we will describe our innovative application of PIF in designing faculty development and engagement programs at our new medical school by leveraging three evidence-based structural characteristics associated with both individual and collective learning (Mount et al., 2022).These characteristics are: Medical Humanism (Thibault, 2019), Communities of Practice (CoP) (Cruess et al., 2018), and Underrepresented in Medicine (URiM) perspectivetaking (Cruess et al., 2015;Spaans et al., 2023), all of which are important for academic medical centers to consider when designing faculty development programs (Figure 1).

Method
Professional Identity Formation as a Faculty Development and Engagement Framework with 3 Structural Characteristics Theorists of PIF in medical education describe the development of professional identity in medicine (Cruess et al., 2015), from an early stage in which an individual is primarily motivated to follow rules and be correct when assuming professional roles, through an intermediate stage, when an individual seeks out those to emulate, and finally arriving at a developed stage when the external values of the profession become internal values of the individual, who is also able to control needs, desires, and passions.
Thus, the PIF process moves the individual from existing personal identities ("who you are") functioning in "legitimate peripheral participation", toward "full participation" in personal and professional identities of becoming a physician in academic medicine ("who you become") (Cruess et al., 2019).We conceptualize this mediating process of socialization to include negotiation, acceptance, compromise and rejection of roles and values, and to rely heavily on a context of social interaction within CoP, acknowledging uniqueness and inclusivity as a substrate of URiM, and embracing internalized values encompassing humanism.It was our deliberate intent to incorporate all of these characteristics into our faculty development and engagement programming.
At the time of this writing, our faculty consist primarily of physicians either with a medical degree (MD) (n = 1033) or an osteopathic degree (DO) (n = 181), both combined equaling 98% of our faculty.The remaining 2% of our faculty hold a research degree (PhD) (n = 31).The duties of faculty vary at the discretion of their department chair, with some having primarily clinical duties, and some having primarily education and research duties.All full-time faculty are required to teach 50 hours per year.Of note, our institution recently transitioned from having faculty at a single hospital to a newly accredited 3-year medical school.As such, it was felt by educational leadership that new programs were necessary to build a working and learning environment with adequate faculty support systems and resources to enhance engagement and efficacy.In doing this, PIF principles were at the foundation of our faculty development and engagement programming, which included:   (Branch et al., 2017).In 2016, the program was revised to create additional venues for collaborative and experiential learning, including required content posted on virtual team discussion boards, new research content in the curriculum in an effort to produce more scholarly deliverables from graduates, and scheduled meetings with educational and research project mentors serving as role models (Cruess et al., 2008).
In its current format, the program consists of two pathways: the Educator Pathway of 12 months in duration, emphasizing curriculum development and teaching methods, and the Researcher Pathway of 18 months in duration, focusing on conducting independent research studies (Kasselman et al., 2022).These pathways encourage faculty to make deliberate choices to enter specific CoP (Wald et al., 2015).The self-directed element of choosing a named pathway is a first step in identifying a desired CoP, in which members have similar developmental goals.Faculty interested in the program must complete an application and be nominated by their Department Chair, who agrees to allow for the time commitment for these faculty members to participate.Chairs are encouraged to nominate attending faculty physicians who have personal ethnic, cultural, socioeconomic, or gender backgrounds that are URiM, to increase mid-career opportunities for professional inclusion.This is pivotal with identity formation as role modeling who are historically URiM is critical for perceived growth as well as retention (Spaans et al., 2023;Trevino & Poitevien, 2021).More so, evidence is currently emerging to suggest that some patient outcomes (communication, satisfaction) can be improved where there is cultural, racial, or ethic concordance between patients and their doctors (Shen et al., 2018;Takeshita et al., 2020).Furthermore, there is rigorous evidence that faculty development programs can increase engagement of members of underrepresented minorities (Steinert et al., 2019).In particular, engaging faculty input on how to improve institutional climate regarding minority faculty advancement plays a significant role in faculty's' perception of the institution, and is suggested to decrease the likelihood that minority member faculty will leave academia prematurely, and abandon scholarly identity formation (Rodriguez et al., 2014).

Faculty mentoring programs.
Mentoring among physicians and health professionals is a crucial part of engagement, retention and satisfaction (Chua et al., 2020;Huggett et al., 2020).
In recognition of this, we have multifaceted programmatic initiatives for mentoring that faculty participate in.All faculty at the Assistant Professor level on the Educator or Scholar tracks, where productivity in teaching and/or research is required in addition to clinical duties, must have a mentor.This mentor meets with them three to four times a year, and mutual collaboration is documented on an Annual Mentoring Letter.This document serves as a tangible, visible piece of evidence that may be helpful in having faculty realize where they presently stand as educators or researchers as their yearly accomplishments are tracked, and new goals are devised for the next academic year.These mentor-mentee matches are another example of formation of CoP.Additionally, the act of mentoring allows individuals to connect with their personal roots and values, to be caring and collaborative (Thibault, 2019).How one perceives their own abilities and their human experience is an important element in Medical Humanism, with self-directed professional learning processes being a primary modality of self-efficacy and creative thinking outlets (Thibault, 2019), and thus having mentors guide mentees on their professional path is an opportunity to capture this.
Recognizing the diverse needs of our faculty, and the importance of having role models for underrepresented minorities and ethnicities, we launched two special interest groups, the Junior Faculty Interest Group (JFIG) and the Women in Medicine group.The JFIG is geared for faculty who are Assistant Professors and with less than 7 years of experience, as a networking group to share resources on going through the academic promotion process, how to find mentorship for support, highlights of buzz topics in academic medicine, and general comradery among faculty in a similar career stage, a less formal but still deliberate opportunity to join a CoP.The group hosts early morning and noontime faculty development sessions with internal and external speakers.The Women in Medicine group was formed as a platform to host topics most pertinent to our faculty identifying as women.The group has hosted workshops focusing on imposter syndrome, negotiation skills, work-life integration, and mastering time.
Additionally, the Women in Medicine group has a particular focus on the number of academic promotions and leadership positions held by women faculty at our institution, as women in medicine are underrepresented in leadership and management roles in many academic medical centers, despite some progress over the last three decades (Yoo et al., 2021).

Faculty coaching program.
Distinguishing from mentoring, our coaching program was launched in 2023 and is available to faculty who require time-limited, task-oriented guidance in either two areas: building and sustaining an educator portfolio, or writing for publication.We have 14 mid to late career faculty who voluntarily serve as coaches to give 1:1 sessions on building educator portfolios and publishing scholarly papers, two areas that our faculty often verbalize the desire for guidance on in their path to academic promotion.This individualized development approach to faculty coaching has a dual-outcome with respect to faculty PIF.For those faculty seeking out coaches, they are able to gain direction tailored to concrete products they will need to finish related to education and research for their own development.Concurrently, the faculty coaches are able to exercise their knowledge and expertise in either education or scholarship, affording them a contribution to their own character as leaders in these areas.
Coaching conversations enable learners' development to promote PIF (Parsons et al., 2021).This continuation of self-directed learning allows for further individual differentiation of faculty professional identity reflection, for both coach-ee and coach (Cruess et al., 2015).
Faculty council.The Faculty Council is the official representative body of our faculty at the school of medicine, established to promote open and frank discussion of issues concerning shared goals of excellence in medical education, clinical care, and scientific research, with special emphasis on supporting the school's mission of promoting excellence in primary care fields of medicine.This council was founded as the medical school was formed and was created to represent and advocate for the faculty, in support of the academic mission of the medical school.The Council focuses on a variety of topics and issues pertaining to faculty and overall professional development, including promotions and tenure, wellbeing, and planning related to medical education.Monthly council meetings are open to all faculty, but information is also disseminated by email, the Council's website, and communications from the elected department representatives.
The Council also runs the elections for school of medicinewide committees, including student progress/promotions, diversity and inclusion, grievance, curriculum, admissions executive committee, and appointment, promotions, and tenure.Each of these committees has both appointed and elected members, and the Council assists the Dean's Office by holding the elections.
We designed our Faculty Council with the tenets of PIF in mind to support our faculty in many ways.By serving on the Council, and/or joining in events or programs, there are several opportunities for faculty engagement.These venues allow for reflection, increased self-awareness, and improved understanding of what aspects of faculty development and wellbeing might be of greatest interest and impact to our faculty, in order to build CoP through social and professional networks and cultivate leadership development (Steinert et al., 2019).
Faculty members who have an interest in getting involved in the Council can choose to do so in one or more of a variety of ways.First, all faculty can benefit from the Council's activities and its work to disseminate information about several resources and the overall infrastructure that exists to support the PIF and overall development of our faculty.Second, faculty can volunteer to serve on one of the Council's standing committees, including academic affairs, benefits and communications, student life, elections, faculty, and planning, budget, and salary.
In addition to the monthly meetings, the Council plans and holds a variety of sessions and events that are designed to promote professional enrichment, networking, and wellness to cultivate PIF.The Council's leadership and communications team also work with other groups and committees to help disseminate information about events and programs that may be of interest to the faculty.Some of the sessions are web-based, others are in person, and others are hybrid.Topics have included education and guidance about the academic promotions process, annual faculty appreciation and social events, clinical practice development, benefits updates, time management, and wellbeing.Additional peer support and wellness events are planned for the current year, as the Council assesses faculty needs formally at least annually and uses that information to plan for the coming year.

Results
To date, we have had 75 Faculty Scholars program graduates that are still active at our institution.Graduates of both the Educator and Researcher pathways (and earlier graduates of the program before there were designated pathways) often return as Faculty Scholars program lecturers, coaches, and mentors in subsequent years, to maintain their relationship within the growing CoP of program alumni.The rich diversity of social relations and peer modeling available within the growing CoP is expected to increase satisfaction of CoP participants and improve the "stickiness" of their extended professional identities.Over half of our Faculty Scholars graduates now hold educational leadership roles at our institution, ranging from directors in undergraduate and graduate medical education, as well as one dean in our medical school.
In the past two years, we have ensured that faculty at the assistant professor level on the Educator and Scholar tracks have had an assigned mentor (87 faculty in 2022, 91 faculty in 2023, respectively).Similarly, in the past year and one quarter, the faculty coaching program has delivered 14 guided sessions on educator portfolios with faculty, and 19 directed sessions on scholarly writing.
Approximately 30 faculty members serve as elected members of Faculty Council committees each year, each serving 3-4-year terms, depending on the committee.Of note, this is in addition to more than 45 other faculty members who have been appointed by the Dean or her/his designee to serve on one or more of these committees.These opportunities have allowed a substantial number of faculty to explore and engage in a variety of meetings, committees, and events that can contribute to their Professional Identity Formation (PIF) relating to CoP and shared governance, increasing their sense of belonging while also helping them to identify areas of personal interest as well as improvement.Each year, more than 45 faculty members serve as standing committee members.
Over the past 5 years, more than 130 different faculty members have served on one or more of these standing committees.
Other faculty members serve as elected department representatives or executive officers of the Council, totaling another 25-30 faculty per year.As the institution and the medical school have grown, so have the size of many departments.Each spring, Council leadership assesses the size of each department, and then calculates the updated number of elected representatives per department for the next academic year.
At the time of this manuscript, 31 faculty serve as elected department representatives, with many others serving as alternates.The size of the Council, based on the number of elected representatives, has grown by approximately 18% over the five years since the Faculty Council was founded.

Future implications for PIF in faculty development and faculty engagement
There is a need to build on the use of PIF in faculty development and engagement initiatives within academic medical centers.In contrast with the quantity of literature reporting in the use of PIF for students and trainees in medical education, there is much room to expand on what is published about PIF in faculty (Mahajan et al., 2022;McMains et al., 2023;Mount et al., 2022).
Many faculty enter our faculty development and engagement programs upon hire anticipating formalized educator and leader roles they can assume in either undergraduate or graduate medical education.Furthermore, faculty express aims to produce more scholarship in the form of peer-reviewed publications, and feel the need to acquire fundamental research skills to assist in their clinical investigations.By immersing themselves in our described programs, participants engage with a community of colleagues with similar interests and goals, and further explore "who they can become" in their careers.
Through the lens of PIF, our faculty development and engagement initiatives allow for learning through peeraffiliations possible in CoP context, with the chance to view role models, give and receive feedback, and obtain direct instruction in a social-relational, as opposed to individualistic, environment.(Cantillon et al., 2019;Irby & Hamstra, 2016).
A continual encounter with peers in CoP extends the premise of PIF further by not only addressing the educator, researcher, and leader identities of faculty when they enter these programs, but also by working on "who they can become" after program participation.
Through our experience in designing and implementing our faculty development and engagement initiatives, we suggest using a few factors to gauge success of the programs: faculty participation, faculty partnerships/collaborations, and emerging roles in education and leadership.
Professional identity is invaluable for the performance, career growth, satisfaction and retention of our physician workforce in academic health centers.By setting forth programmatic initiatives we have described above and drawing upon key characteristics we have outlined such as CoP, Medical Humanism, and URiM, a solid foundation and frame of reference can be built to assist faculty in academic health centers from which future studies in this area can be generated.
The larger field of faculty development may also benefit from future studies examining PIF dynamics compared across health educators and other profession/vocation cohorts.

Maria Blanco
Tufts University School of Medicine, Boston, Massachusetts, USA First, I want to thank you for the opportunity to review your scholarly work and share my thoughts on your paper.As a faculty developer in health sciences education for over twenty-four years, I read your paper with great interest.I believe that sharing our programs allows us to learn from one another's faculty development practices while advancing the field as a whole, and I see your paper as an important contribution to that effort.I commend you for this.
While I can identify the theoretical frameworks that informed your program based on your description, I am still curious about the overall educational design.Specifically, I was hoping the paper would address the learners' needs, program goals, learning objectives, methods, and evaluation approach, and how these components align with the theoretical frameworks in a clear and straightforward manner.Although you describe the different methods and programs offered, I find it challenging to fully understand their cohesive relevance without a clearer description of the underlying educational design.
For example, you could include a roadmap of your design, mapping the objectives of each offering along with their expected processes and outcomes.Additionally, incorporating more literature on faculty development related to evidence-based interventions and existing frameworks on educators' activities and educational scholarship would help better contextualize your program and interventions.
Similarly, I was curious about your program evaluation framework and how it informed the results you report.Regarding your results, I was hoping the paper would discuss how they relate to the professional identity formation of medical educators, beyond simply describing participant engagement in numerical terms.
In summary, for a process-focused paper like this, I would recommend bringing the programmatic design to the forefront.You might consider detailing the individual programs in separate papers, while here providing the objectives and highlights of each to better illustrate the programmatic and theoretical alignment.
Thank you again for the opportunity to review your paper.

Is the rationale for developing the new method (or application) clearly explained? Yes
Is the description of the method technically sound?Yes

Are sufficient details provided to allow replication of the method development and its use by others? No
If any results are presented, are all the source data underlying the results available to ensure full reproducibility?No Are the conclusions about the method and its performance adequately supported by the findings presented in the article?Partly Competing Interests: No competing interests were disclosed.
Reviewer Expertise: faculty development-mentoring-program evaluation-educational research and scholarship I confirm that I have read this submission and believe that I have an appropriate level of expertise to confirm that it is of an acceptable scientific standard, however I have significant reservations, as outlined above.
intent is clear and is a refreshing addition to the copious literature on faculty development in academic health centers.Following are several thoughts/questions for the authors to consider: 1) The general tenor of this manuscript feels like a 'tweener' -somewhere between a quantitative mindset and a qualitative mindset.On one hand, the authors are concerned about generalizability of their PIF-based faculty development initiative to other institutions (e.g."academic medical centers can draw upon the formation of these programs to best serve their faculty"), yet on the other hand, they eschew quantification and structured methods in favor of a rich description of the phenomenon of interest (as noted in their response to a previous reviewers comments #4 & #5).For current purposes, I suggest thinking more qualitatively; perhaps revising this manuscript to read like a case study would make it more easily digestible to readers.Granted, there are already descriptions of several initiatives, but the narratives weren't as insightful as I had hoped, given my interest in the PIF framework that the authors adopted.
2) In healthcare professions, PIF moves towards, "a developed stage when the external values of the profession become internal values of the individual."Yet, it's not clear to me what that 'developed stage' for a healthcare faculty member might look like.For medicine, the ideals and identity of the profession have undergone discussion for generations -appropriately so.My experience in the field is that we don't have much evidence that there is a shared mental model of characteristics for 'healthcare faculty' as a unique profession.
3) In general, this manuscript represents a fascinating new line of inquiry and innovation.I look forward to reading revisions of this manuscript and learning more from this author group!

Is the rationale for developing the new method (or application) clearly explained? Yes
Is the description of the method technically sound?Partly

Steve Taff
Washington University in St Louis, St. Louis, Missouri, USA This is an timely, interesting, and well-written manuscript that further highlights the often subtle (but very important) role of faculty development activities in the ongoing process of professional identity formation.A few comments for the authors to consider include: 1.In the introduction, please consider adding a short discussion of the needs assessment process/data that identified the gaps that these new programs address.

Nicole Rockich-Winston
Pharmacology and Toxicology Department, Medical College of Georgia, Augusta University, Augusta, GA, USA Thank you for the opportunity to review this manuscript.The authors describe approaches to developing professional identity formation (PIF) within faculty development initiatives.The authors offer interesting programs that could be instituted elsewhere for PIF development for academic medicine faculty.
Areas recommended for improvement include: (1) Clearly defining and describing key terms and methods in the Introduction.For example, what do you mean by social-contextual approaches?Also, what has been done already with respect to PIF in faculty development, beyond academic medicine?Why is it important to develop PIF in academic clinicians?
(2) Please include racial/ethnic demographic information in your description of faculty and for those who completed the program.This will help with evaluating whether department chairs are focusing efforts on underrepresented groups in medicine.
(3) As written, the programs would be difficulty to replicate elsewhere because each program lacks a detailed, step-by-step description of what occurs in these programs.Maybe adding a table with more information would help.
(4) The methods section needs a clear description of what and how you measured the success of your programs.Then, this would be reflected in the results section.
(5) Because the data collection is not defined in the methods section, the results section seems a bit disorganized.Once the methods are clearly stated, the results section can be organized around this.Additionally, a table would be helpful in summarizing results.Reviewer Expertise: Mixed method studies, professional identity formation I confirm that I have read this submission and believe that I have an appropriate level of expertise to state that I do not consider it to be of an acceptable scientific standard, for reasons outlined above.
Reviewer's comment: Please include racial/ethnic demographic information in your description of faculty and for those who completed the program.This will help with evaluating whether department chairs are focusing efforts on underrepresented groups in medicine.
Response: While we certainly could include racial/ethnic demographic information about the overall description of our faculty as a whole, this paper is not about one single program and but programmatic development of many initiatives with the underlying framework of PIF.Thus, unclear which aspect you are referring to when you say "completed the program".

2.
Reviewer's comment: As written, the programs would be difficulty to replicate elsewhere because each program lacks a detailed, step-by-step description of what occurs in these programs.Maybe adding a table with more information would help.
Response: While most academic health centers, already have faculty development, faculty mentoring and faculty coaching programs, and there is a wealth of literature on such programs already, this paper is to describe how we applied the underlying framework of PIF for our institution as a whole, while providing examples of our faculty programs.And thus, the focus is on the theoretical application, which we provide the connections to PIF throughout the paper for each aspect of our programming.

3.
Reviewer's comment: The methods section needs a clear description of what and how you measured the success of your programs.Then, this would be reflected in the results section.

4.
Reviewer's comment: Because the data collection is not defined in the methods section, the results section seems a bit disorganized.Once the methods are clearly stated, the results section can be organized around this.Additionally, a table would be helpful in summarizing results.
Response: To points 4 and 5, as this is not a traditional research paper, but a paper describing the application of a theoretical framework to programmatic development, success of our programs was measured as we state in the paper as faculty participation, faculty partnerships/collaborations, and emerging roles in education and leadership.There is no "pre and post" data as in a traditional research paper.

5.
Reviewer's comment: The discussion/conclusion should include a thorough summary of PIF faculty development programs in the literature both inside and outside of medicine.
Response: As we stated in the introduction, the focus of this paper is on academic medical centers, and thus that is where we centralized the literature and the discussion on that.We state early on in the paper that PIF is not as widely reported on for faculty, but more for medical students, and thus we share our experience 6.
through this theoretical application paper to shed light on how other institutions may apply this framework to their own existing programming and/or new programming.
Competing Interests: No competing interests were disclosed. MedEdPublish Are sufficient details provided to allow replication of the method development and its use by others?PartlyIf any results are presented, are all the source data underlying the results available to ensure full reproducibility?Not applicableAre the conclusions about the method and its performance adequately supported by the findings presented in the article?Yes Competing Interests: No competing interests were disclosed.Reviewer Expertise: Medical education curriculum and assessment I confirm that I have read this submission and believe that I have an appropriate level of expertise to confirm that it is of an acceptable scientific standard.Reviewer Report 09 September 2024 https://doi.org/10.21956/mep.21950.r38618© 2024 Taff S. This is an open access peer review report distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

( 6 )
The discussion/conclusion should include a thorough summary of PIF faculty development programs in the literature both inside and outside of medicine.Isthe rationale for developing the new method (or application) clearly explained?Yes Is the description of the method technically sound?Partly Are sufficient details provided to allow replication of the method development and its use by others?No If any results are presented, are all the source data underlying the results available to ensure full reproducibility?Partly Are the conclusions about the method and its performance adequately supported by the findings presented in the article?Partly Competing Interests: No competing interests were disclosed.

Is the rationale for developing the new method (or application) clearly explained? Yes Is the description of the method technically sound? Yes Are sufficient details provided to allow replication of the method development and its use by others? Partly If any results are presented, are all the source data underlying the results available to ensure full reproducibility? Partly Are the conclusions about the method and its performance adequately supported by the findings presented in the article? Yes Competing Interests:
No competing interests were disclosed.

have read this submission and believe that I have an appropriate level of expertise to confirm that it is of an acceptable scientific standard.
© 2024 Rockich-Winston N.This is an open access peer review report distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.